How to Make a Claim

Filing a claim with Chubb is simple. You just need to fill in the claims report and submit the documents required. There are two easiest ways you can submit your claims:

Chubb Mobile Assistance – for accident and health, and auto products

Online Claims Center – for accident and health products only

Chubb Mobile Assistance – for accident and health, and auto products

Submit and manage your medical and auto claims with our innovative application - Chubb Mobile Assistance. With this application, you have more control over the claims process anytime and anywhere. Access these features at your fingertips:

Download the Chubb Mobile Assistance application from the Apple App Store and Google Play Store, and register your policy after the installation. For more information, you may download the ‘How To Use Chubb Mobile Assistance’ guide here.

Online claims center service – for accident and health products

For claims submission of Accident and Health (A&H) products, you may also submit your claims report through our online claims center at https://www.chubbclaims.com/ace/id-id/. With this online claim center, you will be able to access your claims information and status at your convenience.

HEALTH CLAIM SUBMISSION REQUIREMENT & PROCEDURE CLAIM REPORT

As one form of our efforts to provide optimum services, we provide call center services which can be access by the participants. Call Center Services can be accessed through:

Cynergy Care at phone number 021-29552789 or toll free number 0-800-1333111

Or please send an email to below address:

Health.id@chubb.com

DEFINITION

Hospital

An institution which is a legal entity and registered as a Hospital in the country where the hospital is based to provide care and treatment for sickness and injury, and the Hospital:

Has the facility to perform the diagnosis, treatment and major surgery, and provides care 24 hours a day by nurses who have a license, and

Being under constant supervision or headed by a physician and

Not a place for recovery, or a vacation home, nursing homes, rehabilitation centers for people who are addicted to alcohol or drugs, hydro-clinic or the like.

ICU Room

A section of the hospital that is permanently set as the Intensive Care Unit of the Hospital, which is open 24 hours solely to provide emergency care / critical that require audio and visual observation continuously, and are equipped to provide care and specialized medical services that are not available elsewhere in that hospital.

General Practitioners

A doctor who qualified and has diploma in western medical science and has a valid license to practice as a general practitioner that issued by the competent authority of the country in which he practices, and providing care and medical services within the scope of license and expertise.

Specialist

A doctor who has special expertise in western medical science and recognized by the competent authority in the country in which they practices.

Emergency

Health conditions that require immediate healing treatments, in order to avoid death or serious deterioration in the outlook for health, either during the event or for the long term.

Accident

Unexpected events, unplanned, sudden, unforeseen, comes from outside and caused by violence causes bodily injury by accident that regardless of any other cause. Inhalation of gases and vapors and omissions inadvertently consume toxic materials or chemicals are also considered as an accident, with the proviso that only accidental bodily injury that occurs within 30 days from breathed or consumption, it will be considered as the cause of the accident. Drowning is also considered as an accident.

Illness

The physical condition of the deviation from normal and healthy condition.

Excess Costs/Expenses

Costs/Expenses that have been known since the beginning as the obligation of participants, this cost/expenses must be paid by the participant directly to the Hospital / Clinic, such as non- medical expenses (soap, tissue, laundry, sanitary napkins, Pampers and the like).

Excess claim

Medical expenses which are not covered under the insurance policy and become liability of the participant. The excess is known after Chubb received a bill from the hospital / clinic and after going through the process of analyzing the claim is known that medical expenses not covered by Chubb.

Provider

Network Hospitals / Clinics as a partner of Chubb, to provide medical services to the Participant of Chubb’s Health Insurance.

TPA

Third Party Administration, which is a company that has been appointed by Chubb to do management of the claim including guarantee of treatment and customer service.

Service System

Provider System

It is a method of service on a "cashless" basis where by carrying Chubb Health Insurance card, participants can seek treatment to network clinic / hospital provider (partner) who has worked with Chubb health insurance without have to make a payment in cash (except for any costs which are not covered by Health Insurance Policy).

All medical bills will be charged by the clinic / hospital provider to Chubb for further analysis. In case the costs are not covered by the policy, it will be charged as an excess claims to policyholders and to be paid within 14 days to Chubb.

Reimbursement SystemIt is a method of service where participants pay in advance the cost of treatment at the hospital of participant choice, then submit all original invoice including complete claim documents to PT. Chubb through Company HR. All documents will be analyzed according to benefits/ coverage contained in the Health Insurance Policy. Claims payment for the approved claim will be made through the company’s bank accounts (or according to the initial agreement between Chubb with the company).

Procedure of Services

PROVIDER SYSTEM

Inpatient, Surgery and Maternity

PROVIDER SYSTEM

Outpatient & Dental Treatment

PROVIDER SYSTEM

Glasses

Special note coverage Glasses:

Chubb only covers the purchase of glasses with the size of eye refraction that recommended by ophthalmologist.

Purchasing prescription glasses with Optician should be issued prior approval if the participants had to use glasses. This condition does not apply to participants with membership status, child.

Purchasing glasses for children should attach a letter of reference / recommendation ophthalmologist.

Chubb covers the purchase of glasses that have a size of at least 0.5 diopters for minus/plus / cylindris.

Chubb only guarantees the purchase of glasses in case of changes in the size of refraction of the eye or other conditions according to a description in the policy.

Note : This special note applied only if the participant have glasses benefit as stated in the Policy.

REIMBURSEMENT SYSTEM

To obtain settlement of claim reimbursement, participants must submit a claim to Chubb through his company HR, to include all of the requirements necessary claim documents.

All claim documents will be analyzed according to benefits / coverages contained in the Health Insurance Policy. Chubb will settle the claim within 10 working days after the complete claim documents received by the Chubb Insurance

Expired date of claim submission:

30 days after the medical treatment received by participants, for JABODETABEK

60 days after the medical treatment, for outside JABODETABEK

COMPLETENESS OF CLAIM DOCUMENTS

INPATIENT AND SURGERY

Chubb medical claim form completed and signed by the insured and their treating doctor. If claim form not available, can use form that available at the Hospital/Clinic.

Copy of Chubb health membership card.

The original receipts including the breakdown of medical cost during treatment at the hospital

The original breakdown of using medicine during treatment including the cost

A medical certificate from the doctor-in relation to participants hospitalization including the date of commencement of events that resulted in hospitalization, accompanied by the doctor’s signature and seal of the Hospital.

In the case of documents or evidence supporting the claim submission is incomplete, the Health Insurance Chubb will return all documents to the Participant to be completed through Company HR.

No later than 30 days after returning of incomplete documents through HR, claim documents including complete supporting document must be re submitted Chubb to be reanalyzed.

Chubb entitled to request other evidence relating to medical services

MATERNITY

Chubb maternity claim form must be completed and signed by participant and the treating doctor/physician/specialist/midwife.

Copy of Chubb Health Insurance Card

All bills and the complete original receipt from the Hospital related to hospitalization in the hospital, and

All bills and the complete original receipt from Doctor / Specialist / Midwife Letter from doctor or midwife regarding the condition and the expected date of commencement of pregnancy.

OUTPATIENT AND DENTAL TREATMENT

Chubb Health Insurance Claim Form for Outpatient/dental treatment must be completed, signed by Participant and the doctor/ Specialist / Dentist who treated/cared.

Copy of Chubb Health Insurance Card.

Bills and the original complete receipt from Doctor / Specialist / Dentist Copy all the prescription, all of the original bills, and all the original receipt when purchased drugs at pharmacies

Laboratory Examination Result, along with the letter of recommendation to conduct laboratory tests from Doctor / Specialist / Dentist along with all original bills and receipts

Note: *) If the Claim Form of Dental Care/ Outpatient treatment not be carried away by the participants at the time of treatment, on the original receipt must be included medical diagnosis given by a physician who treats with signature and seal of the treating doctor.

GLASSES

Proof of payment of the purchase of lenses and / or frames from official optical, in which the receipts must be in the form of computerized

The results of the examination of the eye acuity from Ophthalmologist or Refraksionis.

Important !

SPECIAL NOTE CARD PARTICIPANTS

Do not carry a Participant’s card

For the case of hospitalization, participants forget or do not carry Chubb health insurance cards, please contact Customer Service Chubb Health Insurance to request initial guarantee letter. Initial guarantee valid for 2 x 24 hours. Participants are expected to be able to show the card Participant after the deadline. If the card is not available, there should be an explanation of the HR company in writing that describe the status of the Card Member.

For outpatient cases, when participants forget or do not carry Chubb health insurance cards, the participant is considered as a public patient. Participants must pay in advance the cost of treatment and subsequently filed a reimbursement claim to Chubb through HR company.

Submission of a new card is lost or damaged should be proposed by the HRD Policyholder / Corporate and administrative charge of printing new cards is Rp 25,000

SPECIAL NOTES FOR INPATIENT BENEFIT

Warranty provisions for Inpatient

Inpatient Guarantee applies if the Participant admitted to the hospitalization within at least eight (8) hours for necessary health care due to illness or accident referred doctor. Especially for surgery, this provision does not apply.

Hospitalization abroad

If participants choose to hospitalization abroad, the system applies reimbursment. Participants must pay the cost of treatment in advance then submit it to PT. Chubb, as reimbursment claims procedure (on page 9).

Entitled Room & Board are not available due to full book

Participants will be placed in room higher one level for 2x24 hour as long as not exceed maximum limit benefit of the Participant as stated in the policy. After a period of 2x24 hours, and the entitled room still not available, then: a. Participants will be moved back to room treatments one (1) levels lower until the room & board as per participant entitlement is available, or b. Participants can still occupy the room with the provision that the participants have to bear the difference in the treatment room since the 3rd day.

If within 2x24 hours Participants entitled room already available, the participants had to move rooms according to their rights. If a participant is not willing to occupy the rooms according to their entitled room, then the participants have to bear the difference in cost of the increase in class since the first day of treatment rooms in accordance with APS (On Self Demand)

Room rate as per Participant entitlement is not available at the Hospital

Participants must occupy a lower room and board rate

If the lower rate is not available, then the Chubb will give tolerance room & board rates by 20% of the room rate at the participants entitled or Rp. 50,000 (whichever is lower)

If the room rate does not exceed the tolerance given rate, the difference rate between entitled room with the occupy room cost will be borne by the participants.

If the rate exceeds the tolerance tariff treatment provided, the benefits are not applicable tariff tolerance by itself and apply the same provisions as the provisions of the conditions of APS (On Self Demand)

Conditions APS (On Demand Self)

That is a condition where since the beginning the room occupied by participant is higher than his entitled room on his own request or Participants treated abroad. In this case, the participant must pay in advance the cost of treatment is going on and then propose reimbursement to Chubb Insurance, as per reimbursement claims procedure (on page 9). The maximum reimbursement is as per conditions listed in the policy.

SPECIAL NOTE FOR OUTPATIENT BENEFITS

Participants were asked to pay in cash for the purchase of vitamins / multivitamins When in network hospital / clinic provider, Participants were asked to pay in cash the cost of purchasing vitamins / multivitamins, participants can still make a claim purchase vitamins / multivitamins on reimbursement basis according to the conditions of the policy.

Terms repetition purchase prescription drugs (iter) Purchasing prescription drugs repetition (iter) a maximum of two (2) times were made within 14 (fourteen) days from the first recipe submitted. Except already get written approval of the medical team Chubb

Excess Cost and Excess Claims

EXCESS COST

Excess costs are those costs which from the beginning has been known to be a participant liability, costs shall be paid by the participant directly to the Hospitals / Clinics.

Completion Excess Cost

If there is excess cost, the Participant is required to pay the entire cost of the excess before leaving the hospital.

Examples of services that result in excess Cost:

Costs not covered by the policy and / or not medically necessary, such as diapers, phone use, perlak, minibar, sanitary napkins, and others.

EXCESS CLAIM

Excess claims are costs that are not covered and being obligation of the Participant. The excess is known after Chubb receive bill from the hospital / clinic and after going through the process of analyzing the claim is known that there are costs that are not covered by Chubb.

Completion Claims Settlement

Chubb will send excess claim letter to the participant through HR Company.

Participants must make payment within 14 (fourteen) days since the date of excess claim letter issued.

With the permission of Policy holder/ Company, Participants can pay the excess claim directly to Chubb

PROCEDURE FOR EXCESS CLAIMS SETTLEMENT BY PARTICIPANT TO CHUBB DIRECTLY:

By bank account transfer, addressed to the following bank account

By a cash deposit, the Parties shall mencantumkam news on deposit payment sheet, which contains:

Company Name

Employee Name

No. Claims (available on excess bill from Chubb)

In this case, participants are required to pay the administrative costs imposed the sender Bank.

By the transfer via ATM, the ATM machine that has the facility to include the sender's message (Non-Cash ATM), the Participant is required to include the sender's message, which contains:

No. Claims (available on excess bill from Chubb)

In this case, participants are required to pay the administrative costs imposed the sender Bank.

If participants make payments through one of the above media without sending news, then after making the payment, participants MUST notify Chubb, via email: Health.ID@chubb.com by stating:

Company Name

Employee Name

No. claims

Nominal payments

Payment of the excess claims in the absence of news or clear information, can not be recorded as a settlement

Craftsmanship in Action: Customer Service Staffs of Chubb in Indonesia Wins Gold and Silver Medals in The Best Contact Center Indonesia 2017 Competition

Competing for the first time, Customer Service team of Chubb in Indonesia won two medals in The Best Contact Center Indonesia 2017 competition, held by the Indonesia Contact Center Association (ICCA).

Branch Admin Servicing Support of Chubb in Indonesia, Fitrya Robbyaniwon a Gold Medal for the Individual, Back Office – Small category, while Customer Service Assistant Manager of Chubb in Indonesia, Neni Agustutiwon a Silver Medal for the Individual, Supervisor – Small category. Aside from that Customer Service, Travel Back Office Agent of Chubb in Indonesia, Karina Sahara and Customer Service Inbound Agent of Chubb in Indonesia, Mariati Lausefaachieved Top 20 positions for the Individual, Back Office – Small categoryand theIndividual, Agent Regular – Small category.

As many as 49 call centers and over 500 individuals competed in four categories – Corporate Program, Teamwork, Talent and Individual. The competing professionals were judged in two stages of competition, and winners were then announced on 11 August 2017 in Jakarta.

Chubb’s participation in The Best Contact Center Indonesia 2017 competition is certainly in line with the company’s commitment to provide consistent superior experience for our customers. This event is seen as one of the efforts to improve service capabilities and to measure service quality delivered to customers.